Introduction
This project focused on the local problem of obese African American children who resided in low-income communities. According to the South Carolina Department of Social Services 2012 Health Report, African American children in low-income
communities had the highest rate of obesity in South Carolina (Callahan-Myrick & Heidari, 2012). The gap-in-practice was the need for interventions, community programs, and health awareness events, which focused on educating parents about the risks, healthy diet, physical activity, and prevention methods of childhood obesity (Hernandez et al., 2012). The practice-focused question for this project was: Does educating parents about the obesity risk factors, healthy weight status, built environment, and prevention
strategies associated with childhood obesity in a low-income community increase their knowledge of healthy lifestyle behaviors?
The purpose of this doctoral project was to support African American parents by increasing their knowledge on obesity risk factors, healthy weight status, and built environment. I collected the data used in the study from African American parents who attended a health promotion faith-based service. Participants (n = 10) completed the COP survey both pre- and posteducation intervention. Surveys were tracked using a numerical system in which numbers were used as code identifiers and tracking logs. Data from the surveys were analyzed using SPSS version 21, and a t test was used to compare the mean scores of the pre- and post-COP surveys. Overall, this project used the SCT to express
that educating these parents on the major factors related to childhood obesity could lead to a positive outcome and decrease childhood obesity in this population.
Finding and Implications
The COP survey was completed by 10 participants in this study. Of the survey participants, (90%) were female and aged 28–54 years. Sixty-percent self-identified as African Americans, and 40% chose not to disclose their race. Of these participants, 80% resided in the local South Carolina county, 30% had a one-parent household, 20% had a two-parent household, and 50% did not respond to the number of parents per household question. Approximately, 60% of the sample described their highest education level as “some college” or a “bachelor degree.” All participants said they worked 30 hours or more, but household income ranged from those making less than $10,000 per year to $74,000 per year. As a result of the education program on childhood obesity, the following outcomes were met:
Parents validated a perceived statistically substantial increase in risk factors and health complications related to childhood obesity.
Parents validated a perceived statistically substantial increase in understanding the importance childhood obesity.
I used the SPSS version 21 to calculate quantitative descriptive statistics. A paired-sample t test was conducted analyzing each survey response using SPSS version 21 to show the comparison of the each presurvey and postsurvey knowledge question response (see Appendix B). In this project, I analyzed the in-depth assessment of five components: (a) risk factors, (b) health complications, (c) weight status, (d) built
environment, and (e) prevention strategies. The Likert-type scale responses on the COP skills tool were coded as follows: 1 = strongly disagree, 2 = disagree, 3 = neither, 4 = agree, and 5 = strongly agree.Table 2 shows the questions that were significant from the surveys. The pre- and postsurvey lowest mean was 1.99 (SD =.87), and the highest mean was 4.80 (SD =.42) (see Table 2). There were multiple responses with a statistically significance of p < .05, which means the of childhood obesity education increased after the intervention. Table 2 below shows selective questions with p < .05. An unanticipated limitation that potentially impacted the findings was the number of participants and the length of the survey, which caused one participant not to complete the postsurvey.
Table 2
Paired Sample t test of Selective Pre and Post Survey Responses
Paired Samples Test Paired Differences t df Sig. (2- tailed) M SD Std. Error Mean 95% Confidence Interval of the Difference Lower Upper Pair 1 Q1 - Q1P - .55556 .88192 .29397 -1.23346 .12235 -1.890 8 .095 Pair 7 Q7 - Q7P -.4000 0 .51640 .16330 -.76941 -.03059 -2.449 9 .037 Pair 8 Q8 - Q8P - .50000 .52705 .16667 -.87703 -.12297 -3.000 9 .015 Pair 9 Q9 - Q9P - 1.1000 0 1.28668 .40689 -2.02044 -.17956 -2.703 9 .024 Pair 10 Q10 - Q10P - .44444 .52705 .17568 -.84957 -.03932 -2.530 8 .035
Risk Factors and Health Complications
Concerning childhood obesity risk factors and health complications, survey participants were likely to strongly agree that lack of money (30% pre, 40% post); parents’ eating habits (70% pre, 60% post); the importance of exercise (60% pre, 50% post); and African American health problems (40% pre, 60% post) were related to a child’s risk for obesity. In addition, participants agreed on the presurvey that if a child
were obese, he or she was likely to develop diabetes (70%), stroke (90%), and cancer (30%). After being educated about these important risk factors, the same participants strongly agreed that childhood obesity would lead to diabetes (70%), stroke (60%), and cancer (50%).
Weight Status
To evaluate the perception of the parents’ idea of the child’s weight, they were asked to choose from different images (see Figure 1). Seventy percent of parents (pre- and postsurvey) reported an underweight child, a healthy weight (20% pre, 10% post), none for overweight, and 10% obese (see Figure 2). Consequently, there was a mixed response for agreed and disagreed regarding participants being concerned about their child’s weight. In addition, 80% of survey participants disagreed or strongly disagreed that their child was obese when completing both surveys, and 70% disagreed or strongly disagreed that their child was overweight.
Figure 1. Picture used to determine parents’ perceptions of child weight status
Built Environment
Fifty percent (pre and post) of participants disagreed that the lack of community programs played a part in increasing childhood obesity rates, while 40% (pre and post) agreed this was an issue. Along with this, 80% (pre and post) agreed or strongly agreed that their child having a playmate in the neighborhood could help prevent obesity. Yet, 99% (pre and post) strongly agreed or agreed that activities were held in their community to motivate their child to engage in some sort of physical activity. Safe communities were an important factor to most (90% post) participants. In addition, there were various responses of those who disagreed (40% pre and post) and agreed (30% pre, 50% post) to the school having a greater ability to preventing childhood obesity than the parents.
Prevention Strategies
Seventy percent of survey participants strongly agreed they could help their children live a healthier lifestyle, and 60% (pre) and 70% (post) had an influence on their children’s weight status. The parents strongly agreed they would encourage preventive strategies such as decreasing sugary drinks (60% post), limiting portion sizes (70% rated this as extremely important), providing healthy snacks (90% rated as extremely
important), increasing exercise (90% post rated as extremely important), and limiting high caloric foods (80% post rated as extremely important). Nevertheless, regarding preventing childhood obesity, 50% (pre and post) strongly agreed their child’s doctor discussed weight with them and explained the growth chart. Most importantly, 60% (post) of the participants stated that their child’s doctor explained preventive measures to prevent childhood obesity.
Implications for Findings
These finding and implementations supported the evidence-based educational intervention within the faith-based health promotion program for the community. Because the church evaluated the effectiveness of previous programs, this project provided concrete data to show the need for similar interventions. The success of the intervention in providing vital knowledge regarding childhood obesity should increase the motivation of parents to work successfully to implement healthy lifestyle factor among their family. This project can also be adapted to other community healthcare providers, churches, health fair coordinators, and community leaders to educate the community’s other programs or health fairs.
Implications for Future Research
Numerous associations could conduct future research using this project as a foundation. Research on the awareness, resources, and built environment for aiding with preventing childhood obesity should be continued throughout other communities.
Families in low-income communities with risk factors associated with childhood obesity should be assessed during community health promotion programs using the evidence- based practice education intervention. Additional research on the interventions,
knowledge level, and lifestyle changes should also be assessed over an extended period. Replication of Alexander et al.’s (2015) study within schools located in low-income communities should also be initiated to allow refinement of the COP instrument and provide more research that focuses on preventing and addressing childhood obesity within a built environment. The introduction of the educational intervention involving an
interactive fun day with at-risk children should also be assessed. Development of nursing knowledge, preventive standards, and treatments is essential to decrease the growing rate of childhood obesity within low income communities.
Implications for Social Change
This childhood obesity project provided education that was beneficial to the parent who resided in built environments and aided in early childhood obesity detection, prevention, and treatments. It is a valuable project tool for the families, the community, and other health professionals to implement to support the decrease of childhood obesity. This community-based awareness project used evidence-based practice and social change knowledge to increase physical activity and healthy eating (Rogers et al., 2013). The association between evidence-based practice and social change will improve the families understanding of the need for healthy behavior changes and promote positive social change to parents within this vulnerable population (Rogers et al., 2013).
Recommendations
The gap-in-practice, as reinforced by the findings of this study, is the necessity for continuous community health involvements and health awareness events aimed at
educating parents about the risks, healthy diet, exercise, and prevention approaches of childhood obesity (Hernandez et al., 2012). Childhood obesity should be a topic that is regularly addressed during community health events in low-income communities. Although the education session during Fitness Sunday in the study site church
community demonstrated significant differences between selected pre- and postsurvey questions, the inclusion of some group education component could provide more
opportunities for participants to ask questions and share personal experiences. More data should be gathered on parents’ perceptions of their built environment and how the parents’ perceptions contribute to childhood obesity. For future studies, qualitative data should be gathered through one-on-one interviews and then analyzed. The participants’ personal experiences might offer researchers other variables to consider as a cause for childhood obesity among those in a built environment.
Contribution of the Doctoral Project Team
The doctoral project team consisted of me the DNP student, health ministry director, the minister, and a fitness expert. The process of working with all team members was professional and initiated valuable relationships for future projects. Each member upheld his or her responsibilities and made certain that the project’s vision, objectives, and goals were met. The health ministry director initiated the surveys, assisted with coding, and assured the security and privacy of all documents. The fitness expert led participants in a physical activity routine as an example of a fun way to help children exercise. Each team member constantly supported the project by expressing to participants the importance of implementing the educational materials provided and proposing the need to extend the project for future programs.
Strength and Limitations of the Project
The main strength of this evidence-based project was to provide knowledge and awareness to a group of African American parents within a built environment. Seeming accomplishment of the project purpose and goals were met based on the significant difference in p-values among the pre- and postsurveys. The location and support from
respectable community stakeholders, such as the minster, were beneficial and motivated participants. Correlations from the demographic data and surveys supported knowledge from parents regrading childhood obesity education. In addition, the face-to face education and the fitness demonstration provided more opportunities for participants to gain an effective education.
The major limitations included the use of a small sample size (n = 10), despite 32 surveys distributed. Other limitations included self-report data and the length of the survey. To address the limitations, more opportunities and small classroom sessions would allow participants to share experiences, concerns, and obstacles. Qualitative data on the parents and children’s experiences regarding their perception of childhood obesity should be collected. These data might provide information related to proposed future research to decrease the rate of childhood obesity in low-income communities.
Summary
The results of this project addressed the goals, objectives, and the overall purpose of addressing childhood obesity in low-income communities. The project team members, faith-based setting, and I, the DNP student. promoted and obtained active involvement from the community. Participants overall gained understanding that childhood obesity is a modifiable disease with major risk factors that can be prevent by increasing knowledge about the disease. In addition, participants’ daily physical activity and eating habits were factors that impacted childhood obesity. The results from the project regarding
inadequate resources and built environment influences in obese children showed these as a barrier of change for the participants. In Section 5, I will outline the dissemination plan
and my final thoughts to ensuring continuous awareness and evidence-based practice of childhood obesity in low-income communities are brought to the forefront to promote positive social change